P-BN36 Trends in Management of Gall Bladder Polyps Over 10 Years

Abstract

Abstract Background Gall Bladder (GB) polyps are abnormal growths on the inner lining that project into the lumen of the GB. They are a rare incidental radiological finding, with a prevalence ranging from 0.3% to 9.5%. The majority of these turn out to be pseudopolyps, however, correct follow up and management is essential to ensure that true polyps, which may be malignant or have malignant potential, are not missed. We hypothesised that a lack of familiarity and poor understanding of the significance of GB polyps, along with the fact that they are frequently noted as an incidental finding by non-surgical specialties, has led to variable management of GB polyps. In order to investigate this, we carried out a retrospective analysis of the management of GB polyps at our large district general hospital over the last 10 years. Methods Patients were identified for this retrospective ten-year cohort study from our database by identifying all patients coded under the ‘International Statistical Classification of Diseases and Related Health Problems (ICD 10) code K 82.8, other specified diseases of gall bladder’. Patients with other diagnoses, such as gall bladder dysfunction, were excluded after review of electronic patient record (EPR) (Sunrise, Allscripts). These records facilitated review of emergency attendances, clinic letters, investigations, and histological results for those diagnosed with a gall bladder polyp. Analysis was performed using Microsoft Excel. Results A total of 154 GB polyps were identified, of which general surgeons diagnosed 63% and 74% went on to have further management. 11% of patients in our cohort proceeded straight to laparoscopic cholecystectomy, 33% underwent planned surveillance, 20% had unplanned scans and 12% were either followed up with the GP or referred back to clinic. A further 26% were discharged. In total, 35% of patients ultimately had a laparoscopic cholecystectomy and the average time from diagnosis to operation was 19 months. There was a strong negative correlation (-0.72) in reduction in time to operation over the 10-year study period. We also identified a decline in patients being followed up over time (-0.14) and in patients receiving no further management post diagnosis (-0.19). Conclusions Management of GB polyps has historically been and continues to be very variable, however, over our 10-year study period we have identified a trend towards operating earlier, with more patients being listed for surgery straight from diagnosis, and more having a shorter period of surveillance. In our cohort there has been no change in number of patients who have further planned surveillance imaging after diagnosis or in numbers of patients discharged with no further investigation or management. We postulate that this variability in management may be due to the fact that GB polyps are often identified as an incidental finding by non-surgical specialists, together with a general lack of awareness of current guidelines and a poor understanding of the pathophysiology.